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NBME 22 Answers

nbme22/Block 1/Question#6

A 2-month-old boy is brought to the physician ...

Human papillomavirus

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submitted by seagull(722),

True vocal cords are often damaged in singing or yelling. THis allows HPV to enter the underlying nucleated cells. HPV 16 and 18 are common subtypes that may cause SCC.

meningitis  Out of all of the virus', HPV has a predilection for stratified squamous epithelium and there is no indication of vesicles(HSV) or linear ulcers (CMV)in the question stem. But with HPV you usually get a big/small (depending on time) unilateral nodule. You are correct to say singing and yelling can cause nodules but these would be bilateral in the and would appear differently. So if a question stem could easily have included that as an option: maybe irritation or something like that. +6  

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submitted by dentist(18),

So do you ignore the distraction about his mother and consider which of the organisms can lead to nodule formation on the vocal cord?

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submitted by chosened(1),

Correct me if I m wrong but I think it's laryngeal papillomatosis. Papillomas can develop anywhere along the respiratory tract, but most often affect the larynx and the vocal cords (laryngeal papillomatosis). Not sure how HY this is but heres More info: https://rarediseases.org/rare-diseases/recurrent-respiratory-papillomatosis/

hyperfukus  yes you are definitely correct i think its a common wtf q that pops up bc there's one on uworld that asks if its true or false vocal cords and i had to hunt my prof down to figure it out... +1  
hyperfukus  also i think they love anything that compromises the airway +  
winelover777  Shout out to Pathoma, Respiratory chapter, Larynx section, Laryngeal Papilloma heading. Only reason I got this question right. +1